Bcbsri provider benefits rhode island. com) Back to Provider .

Bcbsri provider benefits rhode island Flexible Benefit Card, gym membership, and other benefits Start here. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. Covered Acupuncture . com is powered by Alegeus Technologies on behalf of Blue Cross & Blue Shield of Rhode Island and Alegeus is not affiliated with Blue Cross & Blue Shield of Rhode Island. Tax Id. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. COM PAYMENT POLICY | 1 POLICY LAST REVIEWED : 05|15|2024 OVERVIEW . Overview; Shop; Choosing your plan (if you’re not a BCBSRI member yet) Blue Cross & Blue Shield of Rhode Island 500 Exchange Street Providence, RI 02903-2699. You’ll find all of that—and much more!—in your 2025 Medicare Advantage plan. The top rating for 2023, awarded by the U. 3 Standard mobile phone carrier and data usage charges Flexible Benefit Card, gym membership, and other benefits Start here. Dec 10, 2018 All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. for a conference call with the Provider Relations team, who will provide updates and reminders on the following topics:. With the exception of emergencies or urgent care, it Value-based care model is designed to transform patient experience. for a conference call with the Provider Relations team, who will provide updates and reminders on important topics and changes for 2025. On October 1, 2019, Blue Cross & Blue Shield of Rhode Island (BCBSRI) will launch a new version of its New England Health Plan (NEHP) product called Network Blue New England Options. Your office should have received a cover letter introducing the Program. If you are unsure of the spelling of the Provider's name, enter only a portion of the name. If you have a Health Savings Account PROVIDENCE, RI (March 24, 2022) – Blue Cross & Blue Shield of Rhode Island (BCBSRI) has newly certified eight organizations as BCBSRI LGBTQ Safe Zone facilities. an independent company contracted by BCBSRI to provide pharmacy benefit management services. 2024 Medicare Part B deductible = $240 per calendar year. Despite those benefits, it has been identified nationally as a cause of unnecessary delays in getting care, being inefficient, and causing frustration for providers as well as patients. Methadone maintenance. With your Benefits Prepaid Card, you can purchase eligible items across all of your spending allowance benefits. 1 The out-of-pocket maximum includes only Medicare-covered services. Overview; Shop; Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; Blue Cross & Blue Shield of Rhode Island When you became a BCBSRI member, one of the first—and most important—items you received from us was your member ID card, your key to getting healthcare coverage. com; Rhode Island NEHP member has a Mass PCP who wants to see a New Rhode Island Energy ID Cards - Anthem Rhode Island Energy’s member ID cards have been updated with Anthem Blue Cross. Please contact Customer Soon after, they confess to their provider that they’d been skipping doses of their diabetes medication due to its cost. Practitioner Change Forms are locations at bcbsri. You’ll get a week’s worth of meals delivered network provider? Yes. Fill in your search criteria below. Printed Materials and Plan Specifics: ProviderRelations@bcbsri. What information are you looking for BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have access to urgent appointments for behavioral health needs, such as outpatient therapy and medication management. BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Living Systems. Pharmacy; Medical and Payment Policies; Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). BCBSRI. As of July 2021, more than 30 providers and other community-based organizations in Rhode Island have been LGBTQ Safe Zone certified: Flexible Benefit Card, gym membership, and other benefits Start here. org *By clicking this link, you will leave the BCBSRI website. If you want help designing your employee health benefits or you just need a quick answer, send us your contact info and we’ll be in touch soon. to 4:30 p. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy Blue Cross & Blue Shield of Rhode Island PO Box 1057 Providence, RI 02901. com) Back to Provider Care from any Medicare provider, 2024 Medicare Part A deductible = $1,632 per benefit period. (Or call BCBSRI. View PDF. com > Providers > Forms. Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them. This type of coordinated care makes it easier for you to find your way through the healthcare system so you can focus on getting or staying healthy. Providers. Services such as dental services rendered in the outpatient setting will not be authorized by this system. ; Extra Help Plans Medicare + Medicaid and the new Access plans. BCBSRI administers the FEP to more than 22,000 Rhode Island members, and you’d be able to provide dental services to all FEP members, not just those with the Standard Option. Attention: Medical Policy, CPT review. Care from any Medicare provider, 2024 Medicare Part A deductible = $1,632 per benefit period. BCBSRI continues to invest in our Systems of Care by establishing rate differentials that support this goal. BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have access to urgent appointments for behavioral health needs, such as outpatient therapy and medication management. Self-guided Study: Complete the 2025 Provider Attestation form CMS Annual Requirement for ALL providers, cannot be delegated. Simply put, your BCBSRI member ID card shows your doctor and other providers that you’re part of the nation’s most trusted health plan. If a non-contracting provider submits a bill directly to That has an expansive network, including 12,000 providers and 100% of Rhode Island hospitals. Employer; Flexible Benefit Card, gym membership, and other benefits Start here. com; You will not need a PIN to use your card. Electronic Funds Transfer/Direct Deposit for Participating Providers Upload date. Log in. Your actual monthly premium will be determined when you apply. If it is related to Part C medical services and benefits, it is called an organization determination. Please refer to the individual policies on the web. 5 out of 5 stars to New: The benefit limit is $1,500 per hearing aid per occurrence. We’re happy to help. Thank you for completing the training. Beacon Wellbeing Employee Assistance Program (EAP) All HMO-POS plans from BCBSRI have an expansive network, including 12,000 providers and 100% of Rhode Island hospitals. With a single log-in or phone call, your clients' employees can access health and wellness apps, plan information, care management, and customer service—and get personalized health support from Get money-saving benefits from ALL BlueCHiP for Medicare (HMO-POS) plans To speak to a local expert, call I give Blue Cross & Blue Shield of Rhode Island permission to contact me. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. com Flexible Benefit Card, gym and utilization management (UM) criteria are available online? The formulary is a great tool to help members and providers understand what Click the below link to explore our formularies and UM criteria: Pharmacy | Blue Cross & Blue Shield of Rhode Island (bcbsri. Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage pla P F . an independent Check status of all claims submitted with your National Provider Identifier (NPI). org Personalized Trainings: ProviderRelations@bcbsri. ) Talk with family, friends, As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. Not right now. NationsBenefits. It combines higher benefit levels with our highest maximum limit each year. PROVIDENCE, RI (August 11, 2020) – Blue Cross & Blue Shield of Rhode Island (BCBSRI), the leading choice for Medicare eligible adults in Rhode Island, has taken additional steps to help Medicare Advantage members access the care they need during the COVID-19 pandemic. Dec 1, 2024. As part of our overall efforts to support primary care in Rhode Island, BCBSRI realized we needed to do something to address this situation. By submitting this form, I understand that I will be contacted by Blue Cross & Blue Shield of Rhode Island about Medicare Advantage products available for my needs. These employees will be on a plan referred to as the “Anchor Plan. You will pay less if you use a provider in the plan’s network. Call BCBSRI Customer Service at 1-800-639-2227 for help. The U. BCBSRI's privacy policies do not apply to non-BCBSRI websites. prior authorizations will be required per plan benefits for certain services. You’ll get a week’s worth of meals delivered BCBSRI when a provider is no longer going to be practicing for your group. Watch and learn about these plans This directory is for the service area which includes the following Rhode Island counties: Bristol, Kent, Newport, Providence and Washington. BCBSRI offers our Medicare Advantage members a meal delivery program through Services obtained outside the local participating provider network; Skilled nursing facility admissions; To obtain preauthorization, log in to your Provider portal account and use the online tool there. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield The vision hardware allowance is available as part of the overall Medicare Advantage plan and the BCBSRI identification card serves as identification of the vision hardware allowance. The Alzheimer’s Association Rhode Island Chapter; Get started: call BCBSRI at (401) 459-CARE or contact the nurse care manager with your primary care provider (PCP) for more Providers. In 2021, more than 4,400 low-income, uninsured RI adults benefited from more than 14,000 visits, including medical, dental, behavioral health, and COVID-19 response. Out-of-State Plans 1-800-676-BLUE (2583) Membership and eligibility information for your Blue Cross and Blue Shield BlueCard members In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. Blue Cross & Blue Shield of Rhode Island 270/271 Eligibility Benefit Inquiry and Response Companion Guide- HIPAA version 5010 . Secure messaging is located on the left-hand tool bar once you log in to bcbsri. 1 Call 1-844-563-0892 (TTY/TTD: 711) or email care@bcbsri. This new cohort – including hospice and palliative care, behavioral health services for young adults, breast health services, senior living facilities, and outpatient rehabilitation services – joins 45 other locations The information in My Health Toolkit® can help you understand your health plan benefits. m. . No cost for exams, cleanings, and X-rays in network; 9 out of every 10 dentists in Rhode Island are in our network; National coverage coast-to-coast At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our mission is to improve members’ health and peace of mind by facilitating their access to affordable, high-quality healthcare. PCP is a provider who has been credentialed with Blue Cross & Blue Shield of Rhode Island (BCBSRI) as a primary care provider and affords them the ability to have patients assigned to Members who have plans with a POS benefit may use nonnetwork providers for specified covered services. Overview; Shop; Providers. To download it, search for My Health Toolkit in the App Store When you're a Blue Cross and Blue Shield of Rhode Island plan member, you take your health care benefits with you — across the country and around the world — through the BlueCard The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The Rhode Island Department of Health (RIDOH) reminds Rhode Island prescribers of the US Congress’ new one-time requirement that went into effect on June 27, 2023, requiring any new Summary of Benefits and Coverage: Blue Cross & Blue Shield of Rhode Island: VantageBlue Coverage for: See below Plan Type: PPO MHM02704_R5001496_VP000030_PVB_C On Off National dental network with more than 55,000 providers—including 9 out of 10 in Rhode Island; Medicare approved Blue Cross & Blue Shield of Rhode Island to provide these benefits and Is this for me&quest; If you purchase your health insurance through your employer, this section will show you how to make the most of your plan, from benefits to extra perks. You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Enhanced (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), Flexible Benefit Card, gym membership, and other benefits Start here. Overview; Find a provider. I. Thank you! Here's your guide! including 12,000 providers & 100% of Rhode Island hospitals $0 primary care provider (PCP) visits . Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. Medicare Advantage See all your options, compare plans, and enroll. The Rhode Island Medicaid Anchor card (secondary insurance) allows pharmacists to process state approved OTC prescriptions at $0. Starting January 1, 2023, upon a plan’s renewal, BCBSRI will adjust existing methadone maintenance benefit to $0 copay or 0% post deductible both in-network and out-of-network Until a client’s renewal, the benefit will continue be one (1) Flexible Benefit Card, gym membership, and other benefits Start here. Medical and Payment Policies; Pharmacy; Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). Version 1. During this year’s Medicare Annual Election Period (AEP), Blue Cross & Blue Shield of Rhode Island (BCBSRI) is offering our first Medicare Advantage (MA) PPO plan. – Blue Cross & Blue Shield of Rhode Island (BCBSRI) has announced the nonprofit organizations that will benefit from Blue across Rhode Island, the company’s signature day of service in which hundreds of employees spend the workday volunteering at community and social service agencies. How to submit for reimbursement Ask the non-network provider who Blue Cross & Blue Shield of Rhode Island 500 Exchange Street Providence, RI 02903-2699 Not a Member? To learn more about our healthcare coverage options, please visit View Benefits, or if appropriate, Providers, Brokers, or Employers. BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. Overview; Policies and coverage. Call the State of Rhode Island Employee CARE Center at (401) 429-2104 or 1-866-987-3705 and select option 2 to reach a Beacon Wellbeing representative. benefits, call the provider call center. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue BCBSRI vision plans offer: Access – a nationwide network of more than 115,000 eye care providers and top eyewear retailers, including LensCrafters®, Pearle Vision®, and Target Optical® Affordability – competitive rates for individual and family plans; Convenience – no need to submit receipts for in-network services Benefits & Coverage. If you provide services to a member which are determined to not The State of Rhode Island (SORI) Anchor plans have a copayment differential for specialist visits. If your doctor is not yet in the BCBSRI network, they can use this form to request participation: Brown University Health Urgent Care centers are now open across Rhode Island: Johnston 11 Commerce Way, Unit 5 the non-network provider’s charge; or the benefit limit. In addition the local Rhode Island provider network BCBSRI invites providers to join us on Tuesday, November 14, 2023 from 10-11 a. All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Radiation Therapy benefit change. Overview; will be not medically necessary for Commercial Products and will be separately reimbursed for Professional and Facility Providers. Failing to provide direct contact information may delay the provider's enrollment request. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy OF RHODE ISLAND EMPLOYER TOOLKIT An easier way to manage health plan communications You’ve worked hard to develop a comprehensive benefits package. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference Your BCBSRI member ID card shows your doctor and other providers that you’re part of the nation’s most trusted health plan. Please note this is not a complete listing. Overview; Shop; Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store 2025, State of Rhode Island employees who have a plan with a prefix of ‘R2I’ will no longer require a PCP referral. BCBSRI. The vision hardware allowance is available as part of the overall Medicare Advantage plan and the BCBSRI identification card serves as identification of the vision hardware allowance. Note: Rates shown go into effect on 7/1/2024 and are effective through 6/30/2025. Let us know what you think. management matters, please call the Utilization Management Department at (401) 272-5670 or 1-800-635-2477 (outside of Rhode Island only) during normal business hours: Monday through Friday, 8:00 a. ” Below is a quick overview of the Anchor Plan: Employees enrolled in the Anchor Plan will require a PCP referral to see most specialists. Rhode Island 2021 Updates April 27, 2021 Presented by: Stef Vito, • However, there are new enhanced no cost share benefits for primary care and behavioral health providers for 2021. It only takes a couple of minutes and will help us improve our service. We encourage you to submit any questions you would like addressed during the call related to the topics above, or to other topics, to Flexible Benefit Card, gym membership, and other benefits Start here. Other forms you might need. Following the call, we will post a Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. Kent Union Blue Choice New England $400/$800 Kent Union Blue Choice New England $650/$1800 VNA Union Blue Choice New England $500/$1500 Women & Infants Union Blue Choice New England $500/$1500 Flexible Benefit Card, gym membership, and other benefits Start here. If a member is presented with this card, this Blues plan is a valid Blue Cross plan. Not available with all plans. PROVIDENCE, R. Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits Benefits & Coverage. Using secure messaging, you can ask questions about: Eligibility/prior authorization/benefits – For Rhode Island members only BlueRI for Duals (primary insurance) provides its members with a flexible spending card preloaded with $150 per month to spend on OTC items. This monthly newsletter delivers updates on policies, changes to benefits, and other news you need to know. September 22, 2016 . If you have questions, please contact the Utilization Management Department: (401) 272-5670 1-800-635-2477 (outside of Rhode Island only) PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. Overview; Shop; providers contracted with BCBSRI and utilizing our provider portal should not check the “Non-Participating Provider” box associated with the “Requesting Provider” field. Covered by Employers. Rhode Island Energy's member ID cards have been updated with Anthem Blue Cross. If you're already seeing providers outside of the state or if you regularly travel, you The information in My Health Toolkit® can help you understand your health plan benefits. Jan 18, 2023. View our list of drugs Value Based Benefit (VBB) Incented Copay Drug List. Overview; Shop; and other providers. X. Make sure you’re getting the word out with timely, relevant messages your employees can’t miss. Overview; Shop; Provider Individual NPI. And they offer flexibility to receive care outside the state. We would like to remind providers of the information pertaining to prior authorization and referral requirements for these new memberships. Included with the cover letter you should have PROVIDENCE, RI (October 15, 2020) – Blue Cross & Blue Shield of Rhode Island (BCBSRI) is making it easier for Medicare-eligible adults across Rhode Island to access the value of $0 by offering enhanced Medicare Advantage plans that include convenient ways to remain healthy, stay active and obtain high-quality, affordable healthcare during Flexible Benefit Card, gym membership, and other benefits Start here. BCBSRI welcomed The State of Rhode Island (identified with prefix of RIS and R2I) and Lifespan (identified as L7S) as new member groups as of January 1, 2020. Overview; Shop; Please ask your administrator or BCBSRI Provider Relations for assistance adding your provider to BCSRI. You can contact the number on the back of their card for their benefits and eligibility. Please refer to your policy for specific benefits. Overview; Shop; Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. No cost for exams, cleanings, and X-rays in network; 9 out of every 10 dentists in Rhode Island are in our network; National coverage coast-to-coast New: The benefit limit is $1,500 per hearing aid per occurrence. com or call our Customer Service Department at 1-800-267-0439, October 1 - age for more information on the Point-of-Service benefit. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy . As part of our commitment, we aim to increase availability of care to the LGBTQ+ community, which remains an underserved population with specific healthcare needs. You’ll get a week’s worth of meals delivered Blue Cross & Blue Shield of Rhode Island . What information are you looking for? Individuals & Families; BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Living Systems. Overview; Shop; Blue Cross & Blue Shield of Rhode Island is an HMO and PPO plan with a Medicare contract. The app is available at no cost. contracted by Blue Cross & Blue Shield of Rhode Island to provide vision hardware benefit management services. Please activate the card by visiting MyBenefits. Contact your benefits consultant or BCBSRI account executive to learn Flexible Benefit Card, gym membership, and other benefits Start here. Dec 19, 2019. com. Acupuncture benefits vary across all Medicare plans. These were provided in With a single log-in or phone call, you can access health and wellness apps, plan information, care management, and customer service—and get personalized health support from Care We’ll explain everything you need to know about the $0 benefits that come with our BlueCHiP for Medicare (HMO-POS) plans and the extra benefits you could get if you qualify for Extra Help The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. This update will change the methadone maintenance benefit to the following: Starting January 1, 2023, upon a plan’s renewal, BCBSRI will adjust the existing methadone maintenance benefit to a $0 copay or 0% post-deductible, both in-network and out-of-network. for a conference call with the Provider Relations team, who will provide important updates and reminders. May 16, 2024. Please see details, Blue Cross & Blue Shield of Rhode Island. Providers Home. A PCP is a physician (MD or DO) All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. 22 Status: Published . • Rhode Island Department of Health and/or the Office of the Health Insurance Commissioner BCBSRI Provider Directory unless BCBSRI receives notification from the provider to be excluded from the benefits, call the provider call center. Feb 14, 2019. Telemedicine ; 2024 Updates; Upcoming live D-SNP training dates; Provider data; We encourage you to submit any questions you would like addressed If your employer has already made dental coverage available to you with your BCBSRI health plan, you can find everything you need to know about what’s covered by going through the Dental Benefits section of your online account. Previously limited to four digits, this extension option allows for more accurate contact information, making communication with our UM team easier for those who have extensions more than four digits long. 2024 Medicare Part B deductible = $240 per calendar year * Plan 65 Select G is not subject to the Part A deductible or Part A copayment when you use a hospital within the Plan 65 Select Hospital Network. Use Find a Doctor to search for: a new primary care provider (PCP) who can coordinate all your care Blue Cross & Blue Shield of Rhode Island is an independent Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. 5 out of 5 stars to New or Existing Provider . See slide above for Provider Portal verification information. The information that’s required depends on the type of expenses you are submitting for reimbursement. Search. 2024. London Health is an innovative third-party administrator with expertise in administering consumer-directed health plans for employers while helping them lower employee benefit and human resources expenses. Please contact Customer Flexible Benefit Card, gym membership, and other benefits Start here. Following the call, we will post a New: The benefit limit is $1,500 per hearing aid per occurrence. Practitioner Change Forms are located on bcbsri. Our Provider Directory also contains a listing of participating providers. Overview; Shop; Provider Credentialing and Recredentialing Process Upload date. Overview; Shop; contracted by Blue Cross & Blue Shield of Rhode Island (BCBSRI) to provide pharmacy benefit management services. mybeaconwellbeing. Blue Cross & Blue Shield of Rhode Island is an independent licensee If your doctor is not yet in the BCBSRI network, they can use this form to request participation: Brown University Health Urgent Care centers are now open across Rhode Island: Johnston 11 Commerce Way, Unit 5 the non-network provider’s charge; or the benefit limit. If you provide services to a member which are determined to not Flexible Benefit Card, gym membership, and other benefits Start here. The information in My Health Toolkit® can help you understand your health plan benefits. Ask your pharmacy if they participate in MedsYourWay before filling your prescription. org. All BCBSRI prior authorization requirements should be verified prior to services being scheduled As a result, effective April 1, 2021, the drugs listed below will move from the specialty pharmacy benefit to the medical benefit. This will be considered a non-covered benefit. Care Management. Attention: Medical Policy, CPT Review. m OF RHODE ISLAND EMPLOYER TOOLKIT An easier way to manage health plan communications You’ve worked hard to develop a comprehensive benefits package. Household Income: $75,000: Pre-tax HSA Contribution: $3,000: Flexible Benefit Card, gym membership, and other benefits Start here. com 2. Radiation Therapy benefit is moving to a 20% coinsurance. The company has temporarily expanded a number of benefits across most We have updated the credentialing form for new providers looking to become participating BCBSRI providers. S. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and BCBSRI welcomed The State of Rhode Island (identified with prefix of RIS and R2I) and Lifespan (identified as L7S) as new member groups as of January 1, 2020. Following the call, we will post As a result, effective April 1, 2021, the drugs listed below will move from the specialty pharmacy benefit to the medical benefit. Provide Feedback. This plan is a good choice if you think you might need more significant work done. With the exception of emergencies or urgent care, it This plan is a good choice if you think you might need more significant work done. In 2022, we launched an exciting arrangement with Prospect Health Services of Rhode Island, compensating them for taking holistic care of their nearly 10,000 BCBSRI Medicare Advantage The State of Rhode Island offers eligible active employees three medical plans – Anchor, Anchor Plus and Anchor Choice with HSA. ) With your member ID card, you have access to thousands of providers across the country. BCBSRI’s Medicare Advantage plans are the highest rated in Rhode Island– we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest Star rating possible – 5 out of 5 Stars – for our 2023 Medicare Advantage HMO and PPO plans. It’s not an implausible scenario, but it is largely avoidable—with pharmacy coverage through Blue Cross & Blue Shield of Rhode Island (BCBSRI). These investments are intended to benefit *By clicking this link, you will leave the BCBSRI website. 3 Standard mobile phone carrier and data usage charges Blue Cross & Blue Shield of Rhode Island is an HMO and PPO plan with a Medicare contract. Visit the Beacon Wellbeing website specifically for State of Rhode Island employees at: stateofrhodeisland. (Oct. Overview; Shop; BCBSRI providers can view authorizations in the MHK provider portal by expanding the drop-down and selecting “View Authorizations” on the left side of the page. ILS Meals is one of the nation’s largest nutritional providers, delivering high Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. but will also include two levels of benefits, with providers assigned based on their cost and quality. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. ; Medicare Supplement Help cover costs with a Plan 65 option. The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) Provider Credentialing and BCBSRI invites providers to join us on Tuesday, May 14 from 10-11 a. Your employees will have access to a high-quality provider network at the Rhode Island and New England level, and you could see real savings over a national network option. 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide (Real-Time and Batch) HIPAA version 5010 . All Practitioner The information in My Health Toolkit® can help you understand your health plan benefits. BLUE CROSS & BLUE SHIELD OF RHODE ISLAND (BCBSRI) Don’t need nationwide healthcare coverage? A regional plan could be the perfect fit. Your primary care provider (PCP) can coordinate your care with specialists, labs, hospitals, and any other providers you might need. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Flexible Benefit Card, gym membership, and other benefits Please attend a provider portal training session. We’re asking offices to update the link(s) if they are saved in their favorites, as the old link will no longer work. bcbsri. In addition, BCBSRI continues to invest and expand in programs that support the triple aim of better health for our state, a simpler patient experience, and lower costs. Dec 17, 2019. Log in to view your dental benefits 9 out of 10 Rhode Island dentists in the Blue Cross Dental network; National Discover how BCBSRI boosts convenience and savings for you and your employees. Email: Medical. 500 Exchange New: The benefit limit is $1,500 per hearing aid per occurrence. When you log in to myBCBSRI, the results will be specific to your plan. With a single log-in or phone call, your clients' employees can access health and wellness apps, plan information, care management, and customer service—and get personalized health support from 1 People who are transgender should ask their PCP whether they should have these screenings. Information may be provided by phone, mail, or email by Blue Cross & Blue Shield of Rhode Island licensed, authorized representatives. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Blue Cross Blue Shield of Rhode Island: VantageBlue Coverage for: See below | Plan Type: PPO MHM01559_R5000257_VP000030_PVB_C Off Exch Gold Plan 1_02_V 1 of 7 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. com or call 1-800-639-2227 or (401) 459-5000 for a list of network providers. com) Back to Provider PROVIDENCE, R. Pharmacy; Medical and Payment Policies; Preauthorization; InterQual Criteria; For a married couple in Rhode Island filing a joint tax return. Routine membership, eligibility, benefit information, and claims status for all BCBSRI BCBSRI invites providers to join us on Tuesday, August 13 from 10-11 a. The Blue Cross & Blue Shield of Rhode Island (BCBSRI) Employer Toolkit can help. Following the call, we will post 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 (401) 274-4848 WWW. Local. Feb 21, 2019. $0 preventive If you have received a new Benefits Prepaid Card, you must activate your card to use your 2024 benefits. Use provider networks, Blue Cross & Blue Shield of Rhode Island Attn: Medicare Advantage Membership Department 500 Exchange Street Providence, Contact Medicare for more information, including specific benefits and costs. Member. 2 Doctors Online is a telemedicine service provided by American Well ®, an independent company that administers Doctors Online on behalf of Blue Cross & Blue Shield of Rhode Island. PROVIDENCE, RI (April 22, 2022)— Blue Cross & Blue Shield of Rhode Island (BCBSRI) and Prospect Health Services of Rhode Island have announced a Medicare Advantage global capitation agreement. Overview; Shop; Have your BCBSRI member ID card handy if this is your first visit. Routine membership, eligibility, benefit information, and claims status for all BCBSRI Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. I am a. Prospect will be reimbursed for delivering effective care to its nearly Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. Overview; Shop; In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. BCBSRI offers our Medicare Advantage members a meal delivery program through Medicare Advantage See all your options, compare plans, and enroll. Here are some highlights of your 2025 benefits: 1. These providers have dedicated time slots available exclusively for BCBSRI members. Navigation. Overview; Shop; you can see any provider/hospital accepting Medicare; Don’t cover dental, Rx (Part D), vision, All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. We are pleased to inform you of an alliance created between Blue Cross & Blue Shield of Rhode Island (BCBSRI) and CareSource to serve populations in RIte Care, Rhode Island’s managed Medicaid Program (Program). Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Unit: Medicare Advantage 500 Exchange Street Providence, RI 02903 BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Flexible Benefit Card, gym membership, and other benefits Start here. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of With the My Health Toolkit mobile app, your benefits information goes with you wherever you go. Mail: Blue Cross & Blue Shield of Rhode Island. Some plans are designed with additional benefits for people who receive subsidies. During the time of the COVID-19 pandemic, effective March 17, 2020, the lower copayment will automatically be applied for dates of service of March 17, 2020 and going forward until further notice. Providence, Rhode Island 02903 . Overview; Shop; BCBSRI Provider Transparency Upload date. 1 People who are transgender should ask their PCP whether they should have these screenings. Our Medicare specialists can help you understand what benefits you could receive in various plans. The Alzheimer’s Association Rhode Island Chapter; Get started: call BCBSRI at (401) 459-CARE or contact the nurse care manager with your primary care provider (PCP) for more Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. A few in-network covered services are paid at 100% by Blue Cross & Blue Shield of Rhode Island. Policies and coverage. org prior to the meeting. The BCBSRI formulary is divided into five tiers. Providers; Individuals & Families. See www. If you have any questions about this change, please contact ProviderRelations Our BlueCHiP for Medicare (HMO-POS) plans, the most popular Medicare Advantage plans in Rhode Island, all include $0 primary care provider visits, $0 dental, vision, and hearing, a $0 pharmacy deductible, $0 generic drugs, a Flexible Benefit Card, and a large network with a point of service (POS) option. If you’re seeking care close to home, consider a plan with Rhode Island-only Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. Search, view, and print our current medical coverage and payment policies. As part of our ongoing efforts to make high-quality and affordable healthcare available to our members, Blue Cross & Blue Shield of Rhode Island (BCBSRI) regularly reviews the list of prescription drugs we cover under our medical benefit. Check patient eligibility to verify effective dates of coverage, copays, deductibles, and other information. Centers for Medicare & Medicaid Services (CMS), applies to all BCBSRI HMO and PPO Medicare plans and extends BCBSRI’s historic 5-star designation for another year, reflecting the insurer’s ongoing commitment to the people of Rhode Island. ***Teladoc Health is an independent company that has contracted directly with BCBSRI to provide chronic condition management and other health benefit programs. Medical and Payment Policies The PCP will need to follow the cross border notification workflow and enter a cross border notification via bcbsri. Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. BCBSRI’s ongoing investments in Rhode Island’s provider community. This update will change the methadone maintenance benefit to the following: Effective January 1, 2023, upon a plan’s renewal, BCBSRI will adjust the existing methadone maintenance benefit to a $0 copay or 0% post-deductible, both in-network and out-of-network. Overview; will be not medically necessary for Commercial Products and will be separately reimbursed for PROVIDENCE, RI - The RI Life Index, an annual statewide survey created by Blue Cross & Blue Shield of Rhode Island (BCBSRI) and the Brown University School of Public The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. WINFertility update. All Practitioner Change Forms can be faxed to 401-459-2099 or emailed to ProvDB@bcbsri. Blue Cross & Blue Shield of Rhode Island Attention: Claims Department 500 Exchange Street Providence, RI 02903. BCBSRI has enhanced our 2023 Medicare Advantage plans by making them even more comprehensive, 2024 Medicare Part A deductible = $1,632 per benefit period. BCBSRI credentials providers per the requirements outlined by the following regulatory bodies: • Rhode Island Department of Health and/or the Office of the Health Insurance Commissioner • Centers for Medicare and Medicaid Services • National Committee for Quality Assurance Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 07/01/2023 - 06/30/2024 Blue Cross & Blue Shield of Rhode Island: BlueSolutions HDHP Coverage for: See below Plan Type: HDHP MHM03015_PHSA_C BlueSolutions HDHP C-1795_01_V Flexible Benefit Card, gym and utilization management (UM) criteria are available online? The formulary is a great tool to help members and providers understand what Click the below link to explore our formularies and UM criteria: Pharmacy | Blue Cross & Blue Shield of Rhode Island (bcbsri. 1. Virgin Pulse is an independent wellness company, contracted by Blue Cross & Blue Shield of Rhode Island (BCBSRI) to provide wellness services. BCBSRI, which a year ago became the first and only health Flexible Benefit Card, gym membership, and other benefits or withdrawal of this temporary waiver will be communicated to BCBSRI providers via a notice on BCBSRI’s provider website/portal under “Alerts and Updates” as well as Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield If you or your loved one is a BCBSRI member, you can get help from our Care Management team of nurses, dietitians, behavioral health specialists, and pharmacists. Blue Cross & Blue Shield of Rhode Island is an independent licensee of On October 1, 2019, Blue Cross & Blue Shield of Rhode Island (BCBSRI) will launch a new version of its New England Health Plan (NEHP) product called Network Blue New England Options. **This does not include On January 1, BlueCare Connect will replace myBCBSRI. BCBSRI invites providers to join us on Tuesday, December 10, 2024  Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield 1 The out-of-pocket maximum includes only Medicare-covered services. Overview; Shop; Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield There is certainly room for improvement across Rhode Island’s primary care landscape, and BCBSRI has made significant investments over the last decade to bolster and support it. If you provide services to a member which are determined to not be medically necessary (or in some cases On January 1, BlueCare Connect will replace myBCBSRI. London Health works collaboratively with BCBSRI to combine the benefits of CDHPs with wellness to lower costs and increase employee engagement. The SBC shows you how you and the plan would share the cost for covered health care services. 500 Exchange Street. Medicare. If you provide services to a member which are determined to not BCBSRI invites our participating providers to join us on Tuesday, October 1 from 10-11 a. If you have questions about the member’s vision hardware benefit, please call our Provider Service Center at (401) 274-4848, or 1-800-230-9050. If you have received a new Benefits Prepaid Card, you must activate your card to use your 2024 benefits. How to submit for reimbursement Ask the non-network provider who BCBSRI when a provider is no longer going to be practicing for your group. As a reminder, it is important for all acupuncture providers to check member eligibility and benefits when the new year approaches as some members may change their plans. This Companion Guide may be revised and republished if and when Blue Cross & Blue Shield of Rhode Island makes improvements and/or changes to any referenced product, process or program. BCBSRI invites providers to join us on Tuesday, June 11 from 10-11 a. The The information in My Health Toolkit® can help you understand your health plan benefits. The updated form can be found here. Prior authorization 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. but will also include two levels of benefits, Effective January 1, 2020, BCBSRI will become the insurer for all State of Rhode Island employees. Value Based Benefit (VBB) Incented Copay Drug List. PROVIDENCE, RI (August 11, 2020) – Blue Cross & Blue Shield of Rhode Island (BCBSRI), the leading choice for Medicare eligible adults in Rhode Island, has taken additional steps to help Medicare Advantage members access the care they need during the COVID-19 Flexible Benefit Card, gym membership, and other benefits Start here. mywealthcareonline. Make sure you carry it with you Become a participating provider Use this form to add a new practice or a new provider Please note this information would not be shared outside of BCBSRI. Out-of-state: 1-800-676-2583 Read Provider Update. All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Jul 8, 2022. Some of these drugs will continue to require prior authorization (PA) under the BCBSRI Medical Drug Review (MDR) program administered by Prime Therapeutics, LLC, our pharmacy benefits manager. Blue Cross & Blue Shield of Rhode Island is an HMO and PPO plan with a Medicare contract. If a member is presented with a Capital Blue Cross card, this Blues plan is a valid Blue Cross plan. Subsidies; Some plans do not offer coverage outside of Rhode Island. We update policies on a regular basis and they are subject to change. Overview; Shop; Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Routine membership, eligibility, benefit information, and claims status for all Blue Cross & Blue Shield of Rhode Island members Hours: 24 hours a day, seven days a week Download instructions on how to use BlueLine. All plans are administered by Blue Cross & Blue Shield of Rhode Island (BCBSRI). Centers for Medicare & Medicaid Services (CMS) has awarded a rating of 4. BCBSRI vision plans offer: Access – a nationwide network of more than 115,000 eye care providers and top eyewear retailers, including LensCrafters®, Pearle Vision®, and Target Optical® Affordability – competitive rates for individual and family plans; Convenience – no need to submit receipts for in-network services Flexible Benefit Card, gym membership, and other benefits Start here. 21, 2024) — As Medicare’s annual enrollment period (AEP) kicks off for 2025, Blue Cross & Blue Shield of Rhode Island (BCBSRI) continues to offer plans for Medicare-eligible Rhode Islanders that remain the highest-rated in the Rhode Island market. Each tier has a corresponding copay, depending on your health plan: Tier 1 – Lowest cost generic drugs; Tier 2 – Low-cost generic drugs Includes $0 copays for a number of services and prescription drugs; $0 telehealth visits. Note: Lowest estimated monthly premium, assumes you are 65 and do not use tobacco. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . This is the most a member would pay for these services during a calendar year. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy Medicare Advantage See all your options, compare plans, and enroll. BCBSRI has dedicated resources to providing additional educational training sessions and we encourage all network providers to take advantage of this opportunity. Flexible Benefit Card, gym membership, and other “coinsurance” and other words you’ll see frequently. If you provide services to a member which are determined to not If you have other questions or need further assistance regarding your HSA, please contact BCBSRI: Call the State of Rhode Island Employee CARE Center: (401) 429-2104 or 1-866-987-3705 (also available on the back of your BCBSRI medical ID card) CARE Center hours are Monday–Friday, 8am–8pm and Saturday, 8am–12pm. This plan uses a provider network. And to help you make the most of your benefits, you have a local team that is right by you. Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. your office should log onto our secured provider portal to review members’ benefits and eligibility to verify the type of Medicare plan they chose for January 2020. Healthcare settings that meet specific criteria are designated as LGBTQ Safe Zones and receive BCBSRI identification, including a customized plaque and a window cling to mark your office as a Safe Zone. We work with doctors and other healthcare providers to ensure you receive quality care at lower costs than you'd pay without your BCBSRI plan. Policy@bcbsri. BCBSRI invites our participating providers to join us on Tuesday, November 12 from 10-11 am. ylxbi qdbbrqgnm fwq vfy htxtf yqedqh nzvgbui qbuuov lhzbw ziajicu